Acne is unpleasant, but most cases can be treated.
Acne can range from mild pimples, through blackheads, whiteheads and papules, to deep, inflamed, pus-filled cysts and nodules. It is most visible on the face but can occur on the back, chest, neck, shoulders, upper arms and buttocks.
Acne affects boys and girls primarily during puberty but can occur at any age. Statistics show that 8 in 10 preteens have it, and a growing number of women are developing it in their 30s, 40s, 50s, and beyond. Even newborn babies can have it.
Common acne tends to emerge at 8-12 years, as the first sign of puberty. It is most common in girls aged 14-17 and boys aged 16-19. It normally disappears by age 25, though 12% of women and 3% of men will have acne until the age of 44. About 80% of people aged 11-30 will have it at some time. It is not uncommon for women to have a first outbreak when they are 20-35 years old.
Acne affects all races equally, and there is often a family history: if a parent had it, the child is likely to as well.
Despite its prevalence, conflicting and inaccurate information and myths can make acne difficult to deal with. In addition, what helps one person will not help another, and the success of readily available remedies depends on the severity of the condition.
Understanding what causes acne and ways of coping with it can help reduce and even eliminate the negative physical and psychological effects.
What causes acne?
Skin is covered with tiny holes called hair follicles, pilosebaceous follicles or pores. Follicles contain sebaceous oil glands, which produce sebum, the oil that prevents hair and skin from drying out.
Acne forms when sebum and dead skin cells become trapped in a hair follicle.
Dead skin cells normally rise to the surface of pores, to be shed by the body.
During puberty, hormones can cause excess oil production, so that it clumps together with dead skin cells inside the pore and with dirt or oil from outside. The cells and oil become trapped inside the pore, creating a sticky plug: this is acne.
If the bacteria that live on the skin - Propionibacterium acnes - enter the clogged pore, they can multiply quickly, causing inflammation. If the inflammation goes deep into the skin, an acne cyst or nodule appears.
Acne is not infectious, and it is not caused by greasy foods or chocolate, makeup or stress.
Apart from hormonal factors, a link between high glycemic load and acne has been suggested. Oily makeup should be avoided as it can clog up the pores; environmental irritants - such as pollution and high humidity - and oil in the air are also factors. Adult acne may be made worse by smoking.
Dealing with acne
One of the many myths about acne is that it needs to "run its natural course." However, while not physically serious, it can have profound and lasting effects on the individual, which can be alleviated if medical attention is sought.
Acne's impact on self-esteem is well documented; it can lead to anxiety, loss of confidence, social withdrawal and absenteeism from school and work. Grades can suffer; bullying and isolation may occur. Teenage depression and suicidal thoughts have been linked with "bad" acne.
Physical consequences include dark spots on the skin that may take months or years to disappear; cysts and nodules can cause permanent scarring.
All these can be helped or prevented with appropriate treatment.
Types of acne
Dermatologists grade acne in four categories, according to the severity:
- Grade 1 (mild): mostly confined to whiteheads and blackheads, with a few papules and pustules
- Grade 2 (moderate, or pustular acne): multiple papules and pustules, mostly confined to the face
- Grade 3 (moderately severe; nodulocystic acne): numerous papules and pustules; the occasional inflamed nodule; the back and the chest may also be affected
- Grade 4 (severe nodulocystic acne): numerous large, painful pustules and nodules; inflammation.
The type of treatment will depend on the type of acne.
Dos and don'ts
To prevent oil buildup, the face should be washed morning and evening with warm or lukewarm water and a mild, gentle, non-abrasive cleanser. Washing is recommended after exercising, especially when using a helmet or hat, as sweat can cause clogging.
Popping pimples can increase the chance of permanent acne scarring.
Use of a washcloth, mesh sponge or anything else that can irritate the skin should be avoided. Gentle, alcohol-free products are best; astringents, toners and exfoliants can irritate and dry the skin, making the acne look worse. Scrubbing is not helpful; it does not stop acne and can aggravate it.
People with acne should resist touching the face, as oils and dirt from the hands can aggravate breakouts. Equally, picking or popping pimples can make them take longer to clear and lead to scarring.
As oil from the hair can get onto the face, washing hair regularly will help. Oily hair may be washed daily.
Direct sun and tanning beds are not recommended. Tanning damages the skin and increases the long-term risk of melanoma skin cancer by 75%. Moreover, some acne medications make the skin very sensitive to ultraviolet (UV) light, which is increased by exposure to the sun and indoor tanning devices.
On the next page we discuss treatments available for acne.